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REMARKS BY: DONNA E. SHALALA, SECRETARY OF HEALTH AND HUMAN SERVICES PLACE: Rotavirus Colloquium, New Delhi, India DATE: December 1, 1998 TOPIC:
The Pali Canon, a sacred Indian text written over 2,000 years ago, notes simply-yet eloquently-"disease is sorrow." And in 1918-1919, no one would have doubted that statement. Seventy-nine years ago, the worst virus the world has ever known sent a wave of death crashing around the globe. In just eleven months, the Spanish flu pandemic claimed 40 million victims worldwide-possibly half in India-and infected the majority of humanity. Never had a disease been so global in scope.it respected no national border.no national flag.and no family or community.
In cities and towns around the world, the pandemic produced scenes from a Gothic horror novel-but it was all too real. The dead were left in gutters-while death carts roamed the streets in a surreal scene from Medieval times. And as the death toll mounted, orderly life began to break down. Schools and churches closed; farms and factories shut down; homeless children wandered the streets, their parents vanished. The acting U.S. Army Surgeon General calculated that if the pandemic continued its mathematical rate of acceleration-it soon could spell the end of humankind.
But then, as silently, as mysteriously, as quickly as it came, the virus vanished. When the pandemic eventually waned, it was soon pushed off the front pages.and out of the public imagination. Today, it's largely forgotten.
But as we confront a growing number of emerging and re-emerging infectious diseases-from dengue in India to hantavirus in the U.S.-we must not forget the lessons of our century's first plague. Perhaps more than any other epidemic, the Spanish flu episode illustrates that diseases spread across borders of culture, language and territory. We aren't protected, in the words of Indian poet Rabindranath Tagore, "by narrow domestic walls." Diseases can destabilize governments, and destroy fragile communities and economies. Above all, the Spanish flu taught us that there can be no international security without international health security. They are-and always will be-one and the same.
Because infectious diseases recognize no borders, in our fight against them, neither can we. The only way that we can get infectious diseases to exit the world stage is if governments, world health organizations, the private sector and academia work together to attack them with a global strategy. Because we all share a common future, we must stand on common ground.
And because, as we've seen time and time again, when we do work together-we win. In 1977, we eradicated smallpox from every nation on earth-and we removed one of history's deadliest killers from the medical books, and consigned it to the history books. We're now doing the same with measles, hoping to write the final chapter on this childhood scourge. By 1996, measles reached record low levels in the Americas, and transmission of the disease has been interrupted in many other countries. And polio, which once attacked Presidents and poor children alike, may soon join smallpox in the history books. Since 1988, when the World Health Organization launched its campaign to eradicate polio, there's been an 80 percent reduction in reported cases, worldwide. My department is supporting the international assignment of 30 long-term epidemiologists, technical officers, virologists and data managers to help the WHO and various countries combat the disease. And I know that India, which shoulders 60 percent of the world's polio burden, is undertaking a range of polio fighting initiatives-including national immunization days.
We need a similar global strategy-a similar global commitment-if we also want to put an end to the second great plague of the twentieth century-AIDS. As we mark World AIDS Day, we must make it clear that any breach in international solidarity is a victory for the virus. We must remember that AIDS is destroying millions of lives-attacking the body and assaulting the spirit. And because this disease is surrounded by fear and ignorance, those afflicted by it-perhaps as many as 900,000 in the U.S. and at least one million in India- too often face social isolation and the loss of community support. As the nation dealing with more AIDS cases than any other, India must be an important partner in the global effort to develop, evaluate, produce and introduce vaccines to prevent the spread of HIV, and to reduce AIDS deaths in India and around the world.
That's just one of the reasons why I was proud to join Minster Alagh, the Minister of State for Science and Technology, last Friday to sign a joint statement that extends the Indo-U.S. Vaccine Action Program for five more years. One of our most successful partnerships, for 10 years this jointly funded program has sustained a broad spectrum of immunization related activities that benefit both our countries-and the world. It's supported U.S.-Indian vaccine research on cholera, malaria, AIDS, typhoid and other diseases of priority for India. It's improved our understanding of infectious diseases. And it's helping to fill the Indian-and the global-need for new and more effective infectious disease vaccines and diagnostics.
The very existence of the Vaccine Action Program also recognizes that preventive vaccines are among the most cost effective health technologies. And that their widespread use is key to controlling, preventing and one day eradicating many infectious diseases. That day may now be dawning for rotavirus-the most common cause of severe childhood diarrhea. As many of you know, rotavirus globally affects 130 million children under the age of 5 every year. Resulting in possibly 800,000 deaths-That's 800,000 children who will never have the chance to reach adulthood.never have the chance to reach their dreams.And almost 25 percent of these deaths occur in India. In fact, more children die in a single day.every day.every year.from rotavirus.than all the people who have died from Ebola, hantavirus and Lassa Fever, combined, in world history.
But we may now be able to offer these children a lifeline. Because clinical trials have shown that the new, "first generation" vaccine is safe.80 percent protective against severe rotavirus.and capable of preventing the dehydration that actually leads to death. And although tests in Brazil and Peru were inconclusive about the vaccine's effectiveness in developing countries, you may be aware that the latest study from Venezuela shows that the vaccine holds as much promise for the developing world as it does for the U.S. and elsewhere. Routine childhood immunizations for rotavirus could immediately bring the curtain down on a major public health problem.and help lift up the world's children.
The "first generation" rotavirus vaccine is certainly a scientific success story. But we now need to focus our attention on the development and testing of the next generation.vaccines that are being developed to specifically attack the strains of rotavirus found in India.and the first candidate vaccines to ever result from Vaccine Action Program research. These vaccines are promising, but they won't be able to save one child.or spare one family grief.or stop one epidemic.unless we make them available.affordable.and effective. Notice I said "we." In this world without borders, these are challenges that government cannot meet alone. Challenges which require the leadership of the pharmaceutical industry. Challenges that we must meet, not only for rotavirus-but for all new vaccines. And challenges which I want to address today.
Our first challenge is to make vaccines available. This requires an ongoing public-private partnership as we move a new vaccine from development to delivery. We saw that with rotavirus. Only joint public- private research and testing enabled us to reach the point where the "first generation" rotavirus vaccine is ready. The vaccine was originally developed in a lab at the United States' National Institute of Allergy and Infectious Disease, after years of academic and government collaboration. But it couldn't prevent a single illness.it couldn't protect a single child, if it remained sitting on a laboratory shelf. Wyeth Lederle eventually entered into an agreement with the lab to commercially develop it. And both parties contributed personnel, equipment and supplies to the effort-with the government lab also providing funding. When the vaccine was judged ready, Wyeth sponsored the necessary clinical trials which showed it to be safe and effective. And now it's up to the private sector to move the vaccine into marketing...move it from the halls of science into the hands of those who need it.and make it available to the world. Without the private sector's involvement in commercial development and marketing, new vaccines may remain unavailable, and unable to make their appearance on the world's stage.
But once a vaccine is available, then what? That brings us to our second challenge. We need to ensure that vaccines are not only available, but affordable. Although many infectious diseases are democratic- striking the rich and poor without discrimination-it's particularly the developing world that bears the brunt of their attacks. So we must work together to make sure that the price of a new vaccine doesn't put it beyond the reach of those populations that need it most. Tiered pricing arrangements for new vaccines, or other strategies, may need to be instituted for the developing world. I'm reminded that over 2,200 years ago the great Indian leader Asoka-the first universal Emperor of India-was also the world's very first ruler to preach a new, radical notion of government-one based on social compassion. That idea is certainly still relevant for all of us here, as we struggle with the problem of making vaccines affordable for those who need them most.
Our final challenge is to make sure that vaccines are effective-everywhere. For example, I know that in the case of the rotavirus, the "first generation" vaccine is effective against the four most common strains of the disease-which predominate in the developed world. But in some countries-especially India-the diversity of strains is extensive. That's why we may need to develop a second generation vaccine to fight these additional strains. The same is true for any new vaccine-we must ensure that we develop vaccines that will effectively attack every strain of a disease, in every country. And when we're developing them, we also need to study specific regional factors-such as nutrition and sanitation level-which, if not taken into account, can affect the success of many vaccines and our ability to fight infectious diseases.
Think about it-when our century's first pandemic, the Spanish flu, engulfed the world some 80 years ago, we didn't have this ability to fight it. Today, we have the ability to develop weapons to fight infectious diseases-we just need the will.If we're willing to work together, we can meet the challenges of availability, affordability and effectiveness..If we're willing to work together, one day our children will have to turn to the dictionary-and not the newspaper headlines-to find the word "pandemic." And if we're willing to work together, we can guarantee that our children-and their children-will remember the 21st century as a time of health and hope.a time of promise and possibility.a time of medical miracles and scientific marvels. I've no doubt that we can do it.that we must do it.that we will do it.